Placental Histopathologic Changes Associated with Subclinical Malaria Infection and Its Impact on the Fetal Environment

Parekh, Falgunee K.; Davison, Billie B.; Gamboa, Dionicia; Hernandez, Jean N.; Branch, OraLee H.

doi:10.4269/ajtmh.2010.09-0445

Cited by 40 publications

(34 citation statements)

References 30 publications

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“…Levels of anti-VAR2CSA specific IgGs increase with parity, cannot be found in men and are associated with a favourable pregnancy outcome 64–66 so that the malaria risk decreases with increasing parity. Besides the antibody responses to VSA PAM , cytokine responses such as Th1, Th2, interleukins, TNF and regulators, IFN gamma,70–72 and monocytes73 have been observed in pregnant women with malaria. Rosetting, a phenomenon consisting of parasite-free erythrocytes surrounding parasite-infected erythrocytes and commonly observed in non-pregnant individuals, has been implicated in the pathogenesis of severe malaria74–75 but is uncommon in pregnant women with falciparum malaria 76…”

Section: Pathophysiologymentioning

confidence: 99%

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Malaria in Pregnancy

Takem¹,

D’Alessandro

2013

Mediterr J Hematol Infect Dis

133

102

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Pregnant women have a higher risk of malaria compared to non-pregnant women. This review provides an update on knowledge acquired since 2000 on P. falciparum and P.vivax infections in pregnancy. Maternal risk factors for malaria in pregnancy (MiP) include low maternal age, low parity, and low gestational age. The main effects of MIP include maternal anaemia, low birth weight (LBW), preterm delivery and increased infant and maternal mortality.P. falciparum infected erythrocytes sequester in the placenta by expressing surface antigens, mainly variant surface antigen (VAR2CSA), that bind to specific receptors, mainly chondroitin sulphate A. In stable transmission settings, the higher malaria risk in primigravidae can be explained by the non-recognition of these surface antigens by the immune system. Recently, placental sequestration has been described also for P.vivax infections. The mechanism of preterm delivery and intrauterine growth retardation is not completely understood, but fever (preterm delivery), anaemia, and high cytokines levels have been implicated.Clinical suspicion of MiP should be confirmed by parasitological diagnosis. The sensitivity of microscopy, with placenta histology as the gold standard, is 60% and 45% for peripheral and placental falciparum infections in African women, respectively. Compared to microscopy, RDTs have a lower sensitivity though when the quality of microscopy is low RDTs may be more reliable. Insecticide treated nets (ITN) and intermittent preventive treatment in pregnancy (IPTp) are recommended for the prevention of MiP in stable transmission settings. ITNs have been shown to reduce malaria infection and adverse pregnancy outcomes by 28–47%. Although resistance is a concern, SP has been shown to be equivalent to MQ and AQ for IPTp. For the treatment of uncomplicated malaria during the first trimester, quinine plus clindamycin for 7 days is the first line treatment and artesunate plus clindamycin for 7 days is indicated if this treatment fails; in the 2nd and 3rd trimester first line treatment is an artemisinin-based combination therapy (ACT) known to be effective in the region or artesunate and clindamycin for 7 days or quinine and clindamycin. For severe malaria, in the second and third trimester parenteral artesunate is preferred over quinine. In the first trimester, both artesunate and quinine (parenteral) may be considered as options. Nevertheless, treatment should not be delayed and should be started immediately with the most readily available drug.

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Section: Pathophysiologymentioning

confidence: 99%

“…Malaria-associated placental changes have been described for stable72,80 and unstable transmission settings 73,81. They include presence of parasites, inflammatory changes and hemozoin (pigment) deposition.…”

Section: Pathophysiologymentioning

confidence: 99%

Malaria in Pregnancy

Takem¹,

D’Alessandro

2013

Mediterr J Hematol Infect Dis

133

102

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“…Moreover, prospective studies on either placental histopathologic changes in areas of low transmission or the pathologic changes of P. vivax in pregnancy, are scarce. Gestational malaria or placental malaria reports for the Americas are similarly scarce, regardless of the infecting species (Colombia, 29,30 Brazil, [31][32][33] Venezuela, 34,35 Perú , 36,37 Ecuador, 38 and French Guiana 39 ). The aim of this report is to describe the pathologic findings in the placentas of a group of pregnant women from two highly endemic malaria regions in Colombia.…”

Section: Introductionmentioning

confidence: 99%

Placental Malaria in Colombia: Histopathologic Findings in Plasmodium vivax and P. falciparum Infections

Carmona‐Fonseca

Arango

Maestre

2013

The American Society of Tropical Medicine and Hygiene

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Abstract. Studies on gestational malaria and placental malaria have been scarce in malaria-endemic areas of the Western Hemisphere. To describe the histopathology of placental malaria in Colombia, a longitudinal descriptive study was conducted. In this study, 179 placentas were studied by histologic analysis (112 with gestational malaria and 67 negative for malaria). Placental malaria was confirmed in 22.35%, 50.0% had previous infections, and 47.5% had acute infections. Typical malaria-associated changes were observed in 37%. The most common changes were villitis, intervillitis, deciduitis, increased fibrin deposition, increased syncytial knots, mononuclear (monocytes/macrophages and lymphocytes), polymorphonuclear cell infiltration, and trophozoites in fetal erythrocytes. No association was found between type of placental changes observed and histopathologic classification of placental malaria. The findings are consistent with those reported for placental malaria in other regions. Plasmodium vivax was the main parasite responsible for placental and gestational malaria, but its role in the pathogenesis of placental malaria was not conclusive.

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“…In areas where malaria is endemic, pregnant women are more susceptible to malaria infection than their nonpregnant counterparts (14). Susceptibility diminishes over successive pregnancies, when women develop specific antibodies that inhibit the adhesion of the parasite to chondroitin sulfate A, explaining why multigravidae are resistant while primigravidae are susceptible (7,22). As a consequence, malaria infection is more frequent and more intense in primigravidae than in multigravidae.…”

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confidence: 99%

CXC Ligand 9 Response to Malaria during Pregnancy Is Associated with Low-Birth-Weight Deliveries

et al. 2012

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ABSTRACTPlacental infection withPlasmodium falciparumis associated with increased levels of proinflammatory cytokines, including tumor necrosis factor alpha (TNF-α) and gamma interferon (IFN-γ), and previous studies have associated increased levels of these cytokines with low birth weight (LBW), especially for malaria-infected primigravidae. To define the contribution of TNF-α and IFN-γ networks to placental-malaria-associated LBW, we measured chemokines induced by TNF-α and IFN-γ and related them to birth weight in a birth cohort of 782 mother-infant pairs residing in an area ofP. falciparumholoendemicity in Tanzania. Among primigravidae, levels of CCL2, CXC ligand 9 (CXCL9), and CXCL13 were significantly higher during malaria infection in both the placenta and peripheral blood. Placental CXCL9 and CXCL13 levels were also higher in placental blood from secundigravidae and multigravidae. In multivariate analyses adjusted for known predictors of birth weight, malaria-infected primigravidae with placental CXCL9 levels in the lowest tertile gave birth to babies who weighed 610 g more than babies born to mothers with high CXCL9 levels. CXCL9 expression is induced by IFN-γ, and the strong association between birth weight and placental CXCL9 is consistent with previous observations relating IFN-γ to poor pregnancy outcomes.

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Placental Histopathologic Changes Associated with Subclinical Malaria Infection and Its Impact on the Fetal Environment

Cited by 40 publications

References 30 publications

Malaria in Pregnancy

Malaria in Pregnancy

Placental Malaria in Colombia: Histopathologic Findings in Plasmodium vivax and P. falciparum Infections

CXC Ligand 9 Response to Malaria during Pregnancy Is Associated with Low-Birth-Weight Deliveries

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